‘Thinking outside of the box’ to provide better care to patients

In order to establish a recovery-oriented system of care (ROSC) – a system where providers recognize that there are multiple pathways to recovery and that recovery should be an individualized process – providers need to attempt to break down the silos in the field, according to Jennifer Angier, CAC-II, NCAC-II, chief operating officer of Black Bear Lodge, Foundations Recovery Network in Atlanta. Angier was one of three panelists at an Addiction Professional panel series event in Atlanta on Jan. 21.

“We’ve been census driven in the treatment industry,” she explained. Instead of being focused on the financial aspect – getting patients in the door and keeping the treatment center full – it’s important to recognize that when a certain level of treatment isn’t working for a patient they should be moved to another level of treatment, even if that means to another organization.

“Twenty million people need assistance and they’re not coming to treatment,” said Angier. “Not because they can’t afford it, it’s mostly because of the shame associated with receiving care. So as we start to come together and make treatment more accessible in different ways, the doors start to open in different ways.”

She explained that at Foundations, the staff works with a network of providers across the country and doesn’t view anyone as a “competitor.” For example, one of Foundations’ facilities is out of network for BlueCross BlueShield. Because of this, the patient receives a check when he or she leaves treatment and Angier says this is “very concerning” and “dangerous.” In these cases, Foundations will send the patient to another treatment program, such as Ridgeview Institute.

“We would rather lose that income than have the patient receive that check,” she said. “We wanted Ridgeview to get it to be able to help that patient. That is a barrier for the patient to get help. Instead of hoping that maybe the family will bring us the check, we look for all of the different ways to assist them.”

Ending the blame game

Another way of breaking down the barriers for treatment and helping to recognize that there are multiple pathways to recovery is to end an attitude of blame toward patients. Many times when a treatment program doesn’t work, the professional might have the tendency to say, “If this didn’t work it’s because you didn’t want to be here,” or “You didn’t care enough,” or “You really didn’t want to get sober.”

Angier said that this method is “self-serving” and doesn’t help the patient on his/her journey to recovery.

“The patient walked in the door, so obviously they did want to be there. Most of the time it’s that our level of care could not support their needs. So if they struggled it’s easier for us to say it must’ve been them,” she explained.

She believes it’s important to tell the patients up front about the method of treatment that is going to be utilized but also to prepare them for a possible outcome that falls short and let them know about more intensive levels of care that they might need.

By preparing the patient this way, the move into the higher level of care will be much easier. If someone comes into an outpatient program terrified of residential treatment but it is discovered that he or she needs that level of treatment, the program staff can take the time –whether it’s two hours or five days – to work with the patient and move into that level of care.

“We take the time to have the conversation for what makes sense for them instead of trying to fit them inside of our box,” Angier noted.

Extra effort means better care

Angier also talked about working “outside the box” with families and therapists. For example, as long as it feels appropriate and all of the proper releases are signed, Foundations’ staff will attend a session with a client at a private practice to determine what the next best move for him may be.

“It’s really listening to the referring therapist or interventionist,” she said. Additionally, when looking to refer the patient to a recovery residence, she has worked closely with Hope Homes CEO and executive director Beth Fisher, a co-panelist at the Atlanta event. The staff from both organizations know each other and communicate regularly.

“Having those connections, having the names and phone numbers in our cell phones, that’s just the way it has to work,” Angier explained to the audience of addiction professionals. “And having those connections where the relationship is fluid is extremely important.”

Fisher said in the discussion that it’s crucial for staff to be willing to take the time to engage in these extra activities. She said that about five years ago, she received some pushback in her organization from staff who were saying, “We don’t have time to make these phone calls.”

But then she asked the staff, “What can you tell me about their background before they came to treatment? What can you tell me about the pitfalls that they experienced? Do you know how many relapses they’ve had before coming to us?” In response, the staff started to pick up the phone because it couldn’t effectively answer those questions and realized it was missing key pieces.

“It’s not just about here and now,” Fisher explained. “It’s where they’ve been and where they’re going. Meeting people where they are has been shown to be the most effective approach.”